CARE OF AGE
DEFINITION
• Old age: Period of life when impairment of physical and mental functions
becomes increasingly manifested in comparison to the previous years of
life
• Elderly - individual over 65 years old who have a functional impairments
• According to WHO, most developed countries have accepted the
chronological age of 65 years.
• According to UN : 60+ years will be referred as the older population or
elderly.
• Young old – upto 75 years.
• Old old – upto 85 years.
• Very old – over 85 years.
• Elderly care is the fulfillment of the special needs and
requirements that are unique to senior citizens.
• This broad term encompasses such services as assisted living,
adult day care, long term care, nursing homes, hospice care, and
home care
• Geriatric nursing: - Nursing care of the aged patient given in
the home, the hospital, or special institutions such as nursing
homes, psychiatric institutions, etc.
WORLD SCENARIO
• Population ageing is a global phenomenon.
• 703 million persons aged 65 years or over in the world in 2019.
• The number of older persons is projected to double to 1.5 billion in 2050.
• Population ageing has been fastest in Eastern and South-Eastern Asia
and Latin America and the Caribbean.
• Globally, a person aged 65 years in 2015-2020 could expect to live, on
average, an additional 17 years.
• Women’s longevity advantage over men leads to a predominately female
older population. Women tend to live longer than men. At the global
level, in 2015-2020, women’s life expectancy at birth exceeds that of men
by 4.8 years.
INDIAN SCENARIO
• According to the World Bank collection of development indicators,
Population ages 65 and above (% of total) in India was reported at
6.18 % in 2018
• Population aged 65 years or over (thousands) 2019: 87 149 and
expected population in 2030: 128 877
• Percentage aged 65 years or over2019: 6.4 2030: 8.6
Problems associated with old age
• Social
• Financial
• Health
Problems associated with old age
Social
• Indian society is undergoing rapid transformation under the
impact of industrialization, urbanization, technical &
technological change, education and globalization.
• Industrialization has replaced the simple family production
units by the mass production and the factory.
• Negligence by kids towards their old parents.
• Disillusionment due to retirement.
• Feeling of powerlessness, loneliness, uselessness and
isolation in elderly.
• Generational gap.
Problems associated with old age
Financial
• Retirement and dependence of elderly on their child for basic
necessity.
• Sudden increase in out of pocket expenses on treatment.
• Migration of young working-age persons from rural area have
negative impacts on the elderly, living alone or with only the
spouse usually poverty and distress.
• Insufficient housing facility.
Problems associated with old age
• Health
• Multiple disabilities among the elders in old age.
• Health issues like blindness,locomotor disabilities and
deafness are most prevalent.
• Mental illness arising from senility and neurosis.
• Absence of geriatric care facilities at hospitals in rural area.
HEALTH PROBLEMS OF AGED
• Problems due to the ageing process
• Problems associated with long-term illness
• Psychological problems
Problems due to the ageing process
• Senile cataract
• Glaucoma
• Nerve deafness
• Osteoporosis affecting mobility
• Emphysema
• Failure of special senses
• Changes in mental outlook
Problems associated with long-term illness
• Degenerative diseases of heart and blood vessels
• Cancer
• Accidents
• Diabetes
• Diseases of locomotor system
• Respiratory illnesses
• Genitourinary system
Psychological problems
• Mental changes
• Sexual adjustment
• Emotional disorders
Common morbidities of elderly in india
• Cataract &Visual impairment- 88%
• Arthritis & locomotion disorder- 40%
• CVD &HT – 18%
• Neurological problems- 18%
• Respiratory problems including Chronic bronchitis- 16%
• GIT problems 9%
• Psychia tric problems- 9%
Mortality in india
• CVD
• Respiratory diseases
• Infections,TB
• Neoplasm
• Accidents, poisoning and violence
• deaths by chronic diseases
High risk elderly
• Prone for infections
• Prone for injuries
• Prone for psychologic al problems
• Prone for degenerati ve disorders
• Increased risk for disease
• Increased risk of disability
• Incrased risk of death
Life style and healthy aging
• Diet and nutrition
• Exercise
• Weight
• Smoking
• Alcohol
• Social activities
Need for dedicated health care in india
• Decrease in physical ability / Economic inadequacy
• Increase vulnerability to diseases
• Chronic, disabling and multiple Health problems
• Different approach and management
• Degradation in family values
• Rising Population
Major constraints of geriatric health
care
• Lack of specialized and trained manpower
• Geriatrics not yet a popular specialty
• No dedicated health care infrastructure
Prevention
• Primary prevention
• Secondary prevention
• Tertiary prevention
Primary prevention
• Control of BP, weight and diabetes
• Avoid smoking and alcohol
• Regular, moderate physical exercise
• Avoidance of drug abuse and self medication
• Well balanced diet
• Cultivation of interest in reading, listening to music and other
recreational activities.
• Avoid plenty of fluid intake
• Periodical screening for blood pressure, vision and hearing
• Plan for future financial, housing security
• Yoga exercises and meditation
• Immunization against influenza, pneumonia, tetanus, hepatitis B
Secondary prevention
• Educate about danger signals of disease
• Educate woman about BSE
• Pap smear examination for menopause women.
Tertiary prevention
• Cataract surgery, provision of spectacles
• Hearing aids, artificial limbs, prosthesis.
• Physiotherapy, vocational therapy, psychological and social
therapy depending upon the functional capacities.
• Deaddiction counselling
• Establishment of old age homes and old age clubs
• Establishment of geriatric clinics
Legislations
• Maintenance and Welfare of Parents and Senior Citizens Act,
2007
• The Maintenance and Welfare of Parents and Senior Citizens
Act, 2007 was enacted in 31st December 2007, to ensure need
based maintenance for parents and senior citizens and their
welfare
• It accords prime responsibility for the maintenance of parents
on their children, grand children or even relatives who may
possibly inherit the property of a senior citizen
The objectives of the Act are:
• Revocation of transfer of property by senior citizens in case of
negligence by relatives.
• Maintenance of Parents/senior citizens by children/ relatives
made obligatory and justiciable through Tribunals.
• Pension provision for abandonment of senior citizens.
• Adequate medical facilities and security for senior citizens.
• Establishment of Old Age Homes for indigent Senior Citizens.
Various policies and programmes of central government for elderly
people
• National Policy On Older Persons
• National Council for Older Persons (NCOP)
• National Old Age Pension (NOAP) Scheme
• Indira Gandhi National Old Age Pension Scheme
• Integrated Programme for Older Persons (IPOP)
• National Programme for Health Care of Elderly (NPHCE)
• Rashtriya Vayoshri Yojana (RVY)
• Varishtha Pension Bima Yojana (VPBY)
• The Pradhan Mantri Vaya Vandana Yojana
• Vayoshreshtha Samman
• Helpage India
• Annapurna scheme:
National Policy On Older Persons (NPOP)
• Formed in January1999 under Ministry of social justice and
empowerment.
• The goal of the national policy is the well being of older
persons.
• To promote the health, safety, social security and well-being of
elderly in India
• This policy enables and supports voluntary and nongovernmental
organizations to supplement the care provided by the family and
provide care and protection to vulnerable elderly people
This policy has resulted in the opening of new schemes such as –
• Promotion of the concept of healthy ageing.
• Setting up of Directorates of Older Persons in the States.
• Training and orientation to medical and paramedical personnel in
health care of the elderly.
• Assistance to societies for production and distribution of material on
elderly care.
• Strengthening of primary health care system to enable it to meet the
health care needs of older persons.
• Provision of separate queues and reservation of beds for elderly
patients in hospitals.
• Extended coverage under the Antodaya Schemes especially
emphasis for elderly people.
Inter-Ministerial Committee on Older Persons
• An Inter-Ministerial Committee on Older Persons comprising
twenty-two Ministries/Departments, and headed by the
secretary, Ministry of Social Justice and Empowerment is
another coordination mechanism in implementation of the
NPOP.
• Action Plan on ageing issues for implementation by various
Ministries/Departments concerned is considered from time to
time by the committee
National Council for Older Persons (NCOP)
• A National Council for Older Persons (NCOP) was constituted in
1999 under the chairpersonship of the Ministry of Social Justice
and Empowerment to operationalize the National Policy on
Older Persons.
• The council was re-constituted in 2005 and met at least once
every year
• The NCOP is the highest body to advise the Government in the
formulation and implementation of policy and programmes for
the elderly
The basic objectives of this council are to:
• Advise the government on policies and programmes for older persons.
• Represent the collective opinion of elderly persons to the government.
• Suggest steps to make old age productive and interesting.
• Provide feedback to the government on the implementation of the NPOP as
well as on specific programme initiatives for elderly.
• Suggest measures to enhance the quality of inter-generational relationships.
• Provide a nodal point at the national level for redressing the grievances of
older persons which are of an individual nature provide lobby for
concessions, rebates and discounts for older persons both with the
government as well as with the corporate sector.
• Work as a nodal point at the national level for redressing the grievances of
elderly people.
• Undertake any other work or activity in the best interest of elderly people.
National Old Age Pension (NOAP) Scheme
• Under NOAP Scheme, in 1994 Central Assistance was available.
• The amount of old age pension varies in the different States as per
their share to this scheme. It is implemented in the State and Union
Territories through Panchayats and Minicipalities.
• The assistance was available on fulfillment of the following criteria:-
• 65 years or more should be the age of the applicant (male or female)
• The applicants who have no regular means of subsistence from their
own source of income or through financial support from family
members or others.
• The Ministry is now implementing the Indira Gandhi National Old
Age Pension Scheme (IGNOAPS).
Indira Gandhi National Old Age Pension Scheme
(IGNOAPS)
• The Ministry of Rural Development runs the National Social
Assistance Programme (NSAP) that extends social assistance for
poor households for the aged, widows, disabled, and in cases of
death where the breadwinner has passed away.
• Under this scheme, financial assistance is provided to person of
60 years and above and belonging to family living below poverty
line as per the criteria prescribed by Government of India.
• Central assistance of Rs 200 per month is provided to person in
the age group of 60-79 years and Rs 500 per month to persons
of 80 years and above.
Central Sector Scheme of Integrated Programme
for Older Persons (IPOP)
• An integrated Programme for Older Persons (IPOP) is being
implemented since 1992 with the objective of improving the
quality of life of senior citizens by providing basic amenities like
food, shelter, medical care and entertainment opportunities and
by encouraging productive and active ageing.
• Under this scheme financial assistance up to 90 percent of the
project cost is provided to Non-Governmental Organizations for
running and maintenance of old age homes, day care centers
and mobile medicine units
• The scheme has been revised in April, 2008.
Several innovative projects have also been added which are as
follows:
• Maintenance of respite care homes and continuous care homes.
• Sensitizing programmes for children particularly in schools and
colleges.
• Regional resource and training centers for caregivers of elderly
persons.
• Volunteer Bureau for elderly persons
• Formation of associations for elderly.
• Helplines and counselling centers for older persons.
• Awareness Generation Programmes for elderly people and caregivers.
• Running of day care centers for patients of Alzheimer’s
Disease/Dementia, and physiotherapy clinics for elderly people.
• Providing disability and hearing aids for the elderly people.
The eligibility criteria for beneficiaries of some important
projects supported under IPOP Scheme are:
• Old age homes – for destitute elderly persons.
• Respite care homes and continuous care homes – for elderly
persons who are seriously ill and require continuous nursing care
and respite
• Mobile Medicare units – for older persons living in slums, rural
and inaccessible areas where proper health facilities are not
available
National Programme for Health Care of Elderly
(NPHCE)
• National Programme for Health Care of Elderly (NPHCE) is an
articulation of the international and national commitments of
the government as envisaged under (UNCRPD), National Policy
on older Persons (NPOP) adopted by the Government of India
in 1999 and Section 20 of “The Maintenance and Welfare of
Parents and Senior Citizens Act, 2007” dealing with provisional
for medical care of senior citizen.
• It a centrally sponsored scheme under the new initiatives in the
XI five years plan
The vision of the NPHCE is:
• To provide accessible, affordable and high quality long-terms
comprehensive and dedicated care services to an Ageing population.
• Creating a new “architecture” for Ageing.
• To build a frame-work to create an enabling environment for “a society
for all ages”.
• To promote the concept of Active and Healthy Ageing.
• Convergence with National Rural Health Mission, AYUSH and other
line departments like Ministry of Social Justice and Empowerment.
National Policy on Senior Citizens 2011
• The foundation of National Policy for Senior Citizens 2011 is
based on several factors – demographic explosion among the
elderly, the changing economy and social milieu, advancement
in medical research, science and technology and high levels of
destitution among the elderly rural poor
Rashtriya Vayoshri Yojana (RVY)
• This scheme is run by the Ministry of Social Justice and Empowerment.
• This is a central sector scheme funded from the Senior Citizens’ Welfare Fund.
• The fund was notified in the year 2016.
• All unclaimed amounts from small savings accounts, PPF and EPF are to be
transferred to this fund.
• Under the RVY scheme, aids and assistive living devices are provided to senior
citizens belonging to BPL category who suffer from age-related disabilities such as
low vision, hearing impairment, loss of teeth and locomotor disabilities.
• The aids and assistive devices, walking sticks, elbow crutches, walkers/crutches,
tripods/quad pods, hearing aids, wheelchairs, artificial dentures and spectacles are
provided to eligible beneficiaries.
• The scheme is being implemented by Artificial Limbs Manufacturing Corporation of
India (ALIMCO), which is a public sector undertaking under the Ministry of Social
Justice and Empowerment.
Varishtha Pension Bima Yojana (VPBY)
• This scheme is run by the Ministry of Finance.
• The Varishtha Pension Bima Yojana (VPBY) was first launched
in 2003 and then relaunched in 2014.
• Both are social security schemes for senior citizens intended to
give an assured minimum pension on a guaranteed minimum
return on the subscription amount.
The Pradhan Mantri Vaya Vandana Yojana
• The Pradhan Mantri Vaya Vandana Yojana (PNVVY) was launched in May
2017 to provide social security during old age.
• This is a simplified version of the VPBY and will be implemented by the
Life Insurance Corporation (LIC) of India.
• Under the scheme, on payment of an initial lump sum amount ranging
from Rs 1,50,000 for a minimum pension of Rs 1000 per month to a
maximum of Rs 7,50,000/- for a maximum pension of Rs 5,000 per month,
subscribers will get an assured pension based on a guaranteed rate of
return of 8% per annum payable monthly/quarterly/half-yearly/annually.
• The Centre will bear 75 percent of the total budget and the state
government will contribute 25 percent of the budget, for activities up to
district level
PM Garib Kalyan Yojana 2020
• The Indian Government has announced the PM Garib Kalyan
Yojana for the Indian Nationals.
• Home Ministry of India has announced the relief package of 1.7
Lakh Crore under the PMGKY Yojana for the help of the poorest
people to combat the coronavirus.
• For {Widow, Poor Citizens, Disabled, Senior Citizens} – 1000/-
is provided(For Next Three Months)
Some other important activities
• International Day of Older Persons
• Role of Non-Governmental and voluntary organisations:
• Old Age Homes and Day Care Centres:
International Day of Older Persons
• The International Day of Older Persons is celebrated every year
on 1st October
• Resolution 45/106, passed by the United Nations General
Assembly on December 14th 1990, declared October 1st to be
the International Day of Older Persons
• The International Day of Older Persons is an opportunity
to highlight the important contributions that older
people make to society and raise awareness of the
opportunities and challenges of ageing in today's world
Role of Non-Governmental and voluntary
organisations:
• While the government continues its efforts to introduce
programmes for the welfare of the elderly, it is the non-
governmental organisations which have played a key role in
bringing to the forefront the problems of the older people to the
society at large and through its various services it has sown the
seeds for a forum whereby the voice and the concerns of the elderly
can be addressed.
Old Age Homes and Day Care Centres
• Helpage India has sponsored the construction and maintenance of
old age homes in India
• Helpage India • It is a secular, nonprofit, largest voluntary
organization which was set up in 1978
• These homes cater to the needs of those elderly who are unable to
live by themselves and for those who have been abandoned by the
family or are neglected and uncapped for by their children.
SCHEMES OF OTHER MINISTRIES:
• Ministry of Railways
• Ministry of Health and Family Welfare:
• Ministry of Finance:
• Department of Pensions
• Insurance Regulatory Development Authority (IRDA):
• Ministry of Civil Aviation:
• Ministry of Road Transport
• Insurance schemes:
• Senior Citizens Unit Plan (SCUP)
• Medical Insurance Scheme
• Group Medical Insurance Scheme
• Jan Arogya
• Vayoshreshtha Samman
• Conferred as a National award, and given to eminent senior citizens & institutions under various categories for their
contributions on International day of older persons on 1st october.
• Annapurna scheme: Free food grains upto 10 kg per month are provided to destitute older persons above 65 years of age
who are eligible for pension but not receiving it
Ministry of Railways
• Provision of 30 percent discount in all Mails/Express.
• Provision of wheel chairs at stations for the disabled elderly
passengers
• Railway grant 75 percent concession to Senior Citizens
undergoing major heart/cancer operations from starting station
to Hospital station for self and one companion
• Ministry of Health and Family Welfare
• The facility to obtain medicines for chronic ailments up to three
months at a stretch.
• Provision of Geriatric clinic in several government hospitals
• Ministry of Finance:
• Exemption from Income Tax for senior citizens
• Department of Pensions
• set up a Pension Portal to enable senior citizens or elderly to get
information regarding the status of their application, the amount of
pension, documents required etc.
• Insurance Regulatory Development Authority (IRDA):
• Allowing entry into health insurance scheme till 65 years of age
• Ministry of Civil Aviation
• Air India provides concession in air fare up to 50 percent for male
passengers aged 65 years and above and female passengers aged 63
years and above on production of proof of age and nationality on the
date of commencement of journey
• Ministry of Road Transport
• Provided reservation of two seats for elderly or senior citizens in
front row of the buses of the State Road Transport
Undertakings. Some States Governments are providing fare
concession to senior citizens in the State Road Transport
Undertaking buses
• Insurance schemes
• Several types of insurance schemes for the benefit of elderly
people were introduced time to time by several government and
private insurance companies which are – Jeevan Dhara, Jeevan
Akshay, Jeevan Suraksha, Bima Nivesh, Senior Citizen Unit
Plan and several other medical insurance schemes like Group
Medical Insurance Scheme, Jan Arogya etc
• Senior Citizens Unit Plan (SCUP)
• Senior Citizens Unit Plan is a Scheme under which one has to
make a one time investment depending on his/her age and have
the benefit of medical treatment for self and spouse at any of the
selected hospitals on completion of 58 years of age.
• Medical Insurance Scheme
• The Medical Insurance Scheme known as Mediclaim is available
to persons between the age of 5 years and 75 years. The policy is
now available to persons between the age of 5 years and 80
years.
• Jan Arogya
• This scheme is primarily meant for the larger segment of the
population who cannot afford the high cost of medical
treatment. The limit of cover per person is Rs 5,000 per annum.
The cover provides for reimbursement of medical expenses
incurred by an individual towards hospitalisation/ domiciliary
hospitalisation for any illness, injury or disease contracted or
sustained during the period of insurance
RESPONSIBILITIES OF
COMMUNITY HEALTH NURSE
The main objectives of providing nursing care to the elderly are:
• To promote and maintain optimal level of health and function,
detect health problems at an early stage
• To prevent deterioration of an existing disease condition
• To prevent further complications
Health assessment
• Care involves assessing, identification of needs, planning, implementing and
evaluating nursing care.
• Nurses should be aware of the possible complications of the disease and the
treatment as well
• Need to assess the patient’s physical, mental and cognitive skills; understand
their acute and chronic health issues; and the common health concerns, such as
falls, incontinence, changing sleep patterns etc.
Supportive role
• It includes psychosocial and emotional support, enhancing life styles and
relationships, facilitating self expression and ensuring cultural sensitivity
• Consider individuality of the elderly patients. Don’t attempt to alter the lifelong
character and behavior.
• Be patient, kind, sympathetic while providing care. Handle them gently and
maintain privacy while providing care
Educative role
• The nurses should teach self care activities, for example self
medication, continence promotion and health screening
• She can teach the elderly persons about the importance of weight
management, indulging in some sort of physical activities and
exercise , arranging and promoting nutrition and stress
management, thus reducing risks for certain diseases such as heart
attack, stroke, cancer etc.
• Possibly lessen the need for medical treatment.
• The nurse can also assist family members, friends, and others to
receive the knowledge and skills regarding elderly care including
safety, disease prevention, and adherence to medication etc.
Restorative functions
• It include maximizing the independence and functional ability,
preventing further deterioration and/or disability, and
enhancing the quality of life
• Focus on rehabilitation that maximizes the older person’s
potential for independence, including assessment skills and
undertaking essential care elements for example washing,
dressing etc.
Managerial role
• The ‘managerial’ role of the nurses includes the supervision of
care delivered by other staff and the overall management of the
home environment.
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